Deck 11

Question 1

What is the WHO definition of health?

Answer 1

Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.

Question 2

What is Psychosocial wellbeing?

Answer 2

Psychosocial wellbeing resides within the experience of the individual. It is an evaluative reaction to his or her life—either in terms of life satisfaction (Cognitive evaluations) or affect (ongoing emotional reaction) When it goes wrong, you get depression. • Physical – Poor sleep – Weight loss – Low energy/motivation • Cognitive – Negative outlook world, self & future (Beck’s triad) • Emotional – Unhappiness, hopelessness

Question 3

What are the consequences of depression?

Answer 3

• Poor functioning - Worse outcome for co-existing physical illness. - Increased healthcare costs. - £23 billion per annum - Second largest cause of global disability - Suicide risk

Question 4

How are life events linked to depresion?

Answer 4

These are changes that occur suddenly in someone’s life. They don’t necessarily have to be bad, and so can be viewed as being either desirable or undesirable death of a spouse divorce marital separation detention in jail or other institution death of a close family member major personal injury or illness marriage fired from work marital reconciliation retirement change in health or behavior of family member pregnancy sex difficulties. • An excess of life events has been shown to occur in the three months prior to an episode of depression. • risk of depression can increase six-fold in the six months after experiencing markedly threatening life events

Question 5

How do you draw a casual inference from life events being linked to depression?

Answer 5

To draw causal inference… • Check that life event actually preceded depression – Prospective study • Find out what type of life event – Dependant and independent life events  Dependant: may be secondary to depression – Losing job due to symptoms of depression  Independent: do not occur as a result of symptoms of an illness – Losing job due to cost saving. • Recall bias is a common problem in case control studies, • People with a disorder recall exposures differently than people without disorders

Question 6

How do we minimise recall bias?

Answer 6

• Ask a relative - Use life events that can be independently verified. - Follow people up prospectively following a life event.

Question 7

What is the ‘Wilkinson Hypothesis’

Answer 7

• More unequal societies are sicker, less happy and less cohesive. - Not absolute, but relative levels of wealth are important.

Question 8

What is adjustment disorder (AD)?

Answer 8

• Adjustment disorder (AD) sometimes called exogenous, reactive or situational depression, occurs when an individual is unable to adjust to or cope with a particular stressor, like a major life event. Since people with this disorder normally have symptoms that depressed people do, such as general loss of interest, feelings of hopelessness and crying, this disorder is sometimes known as situational depression. Unlike major depression, the disorder is caused by an outsider stressor and generally resolves once the individual is able to adapt to the situation. The condition is different from anxiety disorder, which lacks the presence of stressor, or PTSD and acute stress disorder, which usually are associated with a more intense stressor (an explosion, a car accident, a miscarriage).

Question 9

What are the emotional signs of adjustment disorder?

Answer 9

 Sadness  Hopelessness  Lack of enjoyment  Crying spells  Nervousness  Anxiety  Worry  Desperation  Trouble sleeping  Difficulty concentrating  Feeling overwhelmed and thoughts of suicide

Question 10

What are the behavioural signs of adjustment disorder?

Answer 10

Fighting  Reckless driving  Ignoring important tasks such as bills or homework  Seeking approval from others by any way possible (cheating/lying/escaping reality)  Avoiding family or friends  Performing poorly in school  Skipping school  Vandalizing property

Question 11

What are the stages of adjustment?

Answer 11

1. Shock  Anxiety  Bargaining  Denial  Mourning  Depression  Withdrawal  Internalized anger  Externalized aggression  Acknowledgement  Acceptance  Adjustment

Question 12

What are the ways in which major physical changes may impact on personal relationships?

Answer 12

• May be unable to partake in (certain) sex acts. - May be unable to work (financial strain, family may have to work harder for more income, may not see friends/colleagues as often) - Loss of identity if that function prevents you from doing activities and fulfilling certain roles that you have always felt were part of your identity: o Occupation o Hobbies o Parenthood o Etc May be seen as unable to do things even if you are

Question 13

What is grief?

Answer 13

Grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioural, social, spiritual, and philosophical dimensions. Bereavement refers to the state of loss, and grief is the reaction to loss.

Question 14

What is the grieving process?

Answer 14

Every step of the process is natural and healthy. It is only when a person gets stuck in one step for a long period of time that the grieving can become unhealthy, destructive and even dangerous. Going through the grieving process is not the same for everyone, but everyone does have a common goal; acceptance of the loss and to keep moving forward.[5] This process is different for every person but can be understood in four or more stages, depending upon the theory that is being used. Shock and Denial - Shock is the initial reaction to loss. Shock is the person’s emotional protection from being too suddenly overwhelmed by the loss. The person may not yet be willing or able to believe what their mind knows to be true. This stage normally lasts two or three months. Intense Concern - Intense concern often manifests by being unable to think of anything else. Even during daily tasks, thoughts of the loss keep coming to mind. Conversations with one at this stage always turn to the loss as well. This period may last from six months to a year. Despair and Depression - Despair and depression is a long period of grief, the most painful and protracted stage for the griever (during which the person gradually comes to terms with the reality of the loss). The process typically involves a wide range of feelings, thoughts, and behaviors. Many behaviors may be irrational. Depression can include feelings of anger, guilt, sadness and anxiety. Recovery - The goal of grieving is not the elimination of all the pain or the memories of the loss. In this stage, one shows a new interest in daily activities and begins to function normally day to day. The goal is to reorganize one’s life, so the loss is an important part of life rather than its center

Question 15

What are the five grieving identities according to Berger?

Answer 15

1. Nomads: Nomads have not yet resolved their grief and do not seem to understand the loss that has affected their lives. 2. Memorialists: This identity is committed to preserving the memory of the loved one that they have lost. 3. Normalizers: This identity is committed to re-creating a sense of family and community. 4. Activists: This identity focuses on helping other people who are dealing with the same disease or with the same issues that caused their loved one’s death. 5. Seekers: This identity will adopt religious, philosophical, or spiritual beliefs to create meaning in their lives.

Question 16

What are the five stages of grief theory according to elizabeth kubler-ross?

Answer 16

The popular but largely untested theory describes in five distinct stages how people deal with grief and tragedy. Such events might include being diagnosed with a terminal illness or enduring a catastrophic loss. The five stages are: 1. denial 2. anger 3. bargaining 4. depression 5. acceptance The theory holds that the stages are not stops on a linear time line of grief. The theory also states that not everyone goes through all of the stages, nor in a prescribed order. George Bonanno conducted large, peer-reviewed studies which actually showed that the vast majority of people do not grieve, but are resilient.

Question 17

What are the four trajectories of grief theory according to george bonanno?

Answer 17

 Resilience: “The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning” as well as “the capacity for generative experiences and positive emotions.”  Recovery: When “normal functioning temporarily gives way to threshold or sub-threshold psychopathology (e.g., symptoms of depression or Posttraumatic stress disorder, or PTSD), usually for a period of at least several months, and then gradually returns to pre-event levels.”  Chronic dysfunction: Prolonged suffering and inability to function, usually lasting several years or longer.  Delayed grief or trauma: When adjustment seems normal but then distress and symptoms increase months later. Researchers have not found evidence of delayed grief, but delayed trauma appears to be a genuine phenomenon.

Question 18

What is complicated grief?

Answer 18

Prolonged grief disorder (PGD), formerly known as complicated grief disorder (CGD) is a pathological reaction to loss representing a cluster of empirically derived symptoms that have been associated with long-term physical and psycho-social dysfunction. Individuals with PGD experience grief symptoms for more than 6 months and are stuck in a maladaptive state. Researchers have found that 10-12% of people experience a prolonged response to bereavement that impacts functioning and has adverse long-term effects on health. People with PGD feel “stuck” in their grief, a chronic aching and yearning for a cherished person who is now gone, feel that they are not the same person anymore (e.g., unsure of their identity, loss of a sense of self and self-worth), feel emotionally disconnected from others, and lack the desire to “move on” (and sometimes feeling that doing so would be a betrayal of the person who is now gone).

Question 19

PDG symptoms have been associated with..

Answer 19

 Elevated rates of suicidal ideation and attempts  Cancer  Immunological dysfunction  Hypertension  Cardiac events  Functional impairment  Adverse health behaviours  Reduced quality of life in adults and in children  Increased health service use and sick leave

Question 20

What are the four aspects of learning disability?

Answer 20

1) Significant impairment in intelligence - IQ 2) Significant Impairment in adaptive behaviours o Reading, writing, numeracy, self-care etc 3) Significant impairment in social functioning o Varies with diagnosis – e.g. much greater in autism o Need for support 4) Onset during the developmental period (<18 years old)

Question 21

Summarise the forms of multiple intelligence

Answer 21